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Ann Thorac Surg 2005;80:543-547
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

A Multidisciplinary Network To Save the Lives of Severe, Persistent Cardiogenic Shock Patients

Aly El-Banayosy, MD * , Dagmar Cobaugh, MD, Armin Zittermann, PhD, Lukasz Kitzner, MD, Latif Arusoglu, MD, Michiel Morshuis, MD, Hendrik Milting, PhD, Gero Tenderich, MD, Reiner Koerfer, MD

Department of Cardiothoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany

Accepted for publication March 7, 2005.

* Address reprint requests to Dr El-Banayosy, Department of Cardiothoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany (Email: abanayosy{at}hdz-nrw.de).

BACKGROUND: Severe, persistent cardiogenic shock is associated with very high morbidity and lethality. We therefore tried to improve the outcome of these patients using a network between local hospitals and a specialized heart center that has facilities for transplantation and ventricular assist device (VAD) implantation.

METHODS: Between 1998 and 2000, 50 patients, who were in cardiogenic shock (mean age 49 years, SD 14) despite high doses of at least three inotropic agents, were admitted to our specialized heart center. During the first 12 hours, we tried to stabilize the patient’s condition, to reduce inotropic support agents, and to keep cardiac index above 2.4 L·min–1 ·m–2. According to this strategy, patients were allocated to medical treatment only, emergency VAD therapy, urgent VAD implantation, or heart transplantation. To assess variables potentially influencing patients’ outcome, we performed univariate and multivariate analyses.

RESULTS: Early in-hospital mortality was 36% and late mortality was 10%. Overall survival at 1, 6, and 12 months of follow-up was 70%, 56%, and 52%, respectively. Even when the heart transplant patients were excluded, overall 12-months survival after cardiogenic shock was still 50%. Higher age, and the absence of sinus rhythm were the only independent risk factors for 12-month mortality.

CONCLUSIONS: Our data show that a network between cardiology departments of local hospitals and specialized heart centers can be life-saving for severe, persistent cardiogenic shock patients.






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